Using the principles of communication theory we will develop and evaluate a new strategy for the informed consent process. Our goals are: 1) to identify the effects of informed consent procedures on patient understanding, attitudes, behaviors, and 2) to increase the utility of these procedures for all participants, both the patients and the physicians. The new procedure (to be studied in a randomized controlled trial experiment) includes: 1) providing the patient with information prior to the decision whether to have elective surgery, 2) giving the patient the time to assimilate the information, 3) involving the patient's spouse for support and reinforcement, and 4) providing feedback to the physician about the patient's level of "informedness". The specific differences to be assesed include: 1) patient's level of knowledge of risks, benefits and alternatives; 2) patient's perception of and attitudes toward participation in decision-making; 3) patient's additional information-seeking behaviors; 4) patient's evaluation of spouse's involvment; 5) patient's anxiety levels before and after surgery; 6) patient's satisfaction with physician-patient communication; 7) physician's satisfaction with physician-patient communication. Other indicators which will be monitored (although the sample size is too small to anticipate significant differences) are: 1) morbidity levels/complication types and rates; 2) recovery time; 3) refusal rates for surgery. These factors will be measured by pre- and post-surgery home interviews with the patients, assessments by physician and briefing nurse, and audit of the clinic and hospital records.